Helping the primary care system identify, plan, and care for seriously ill, frail elderly
Canadians nearing the end-of-life (EOL) do not always receive the best care possible. This study seeked to help family doctors plan and care for older adults who are frail and may be approaching EOL.
Possible Research Results
Anticipated findings: (1) A valid identification rule to identify older adults at risk of declining health or dying; and (2) information to help move this tool into practice and to help family doctors engage patients in advance care planning (ACP).
Impact of findings: A tool to identify patients in family practices who are nearing EOL will assist and guide physicians on how to approach ACP conversations with patients. Frail older adults and their families are thus more likely to receive care that matches their goals and wishes, and have better care experiences at EOL.
About the Project
Doctors find it difficult to know when patients are nearing EOL. As a result, patients who would benefit from having conversations with their doctors about their goals and wishes for care (i.e. ACP) are often identified when it is too late for these to be met. This can lead to unwanted care for patients at EOL, and stress and anxiety for families.
The main objective of the study is to create an "identification rule" using information from the electronic medial records (EMR) of patients, to notify doctors when a patient is nearing EOL, as well as understanding how it can be integrated in doctors' offices.
Research Plan: (Nova Scotia & Ontario): (1) Identification rule development and validation using information from family doctors’ EMRs from across Canada. (2) Focus groups with family doctors to understand how the identification rule can be best put into practice in doctors’ offices. (3) Focus groups (with doctors, nurses and healthcare managers/administrators) and interviews (with older adults and family members) to understand views on using an identification rule and on how family doctors should start ACP conversations once a person is identified. (4) Stakeholder dialogues to obtain guidance about how to move forward with early identification in Canada.
Robin Urquhart, PhD -- Dalhousie University
Fred Burge, MD, FCFP, MSc -- Dalhousie University
Richard Birtwhistle, MD, MSc, CCFP, FCFP -- Queen's University
Colleen Cash, BA, BBA, MSHA -- Nova Scotia Hospice Palliative Care Association
Grace Johnston, BSc, MHSA, PhD -- Dalhousie University
Jyoti Kotecha, BSc (Hons), MPA, PhD(c) -- Queen's University
Francis Lau, BSc, MSc, MBA, PhD -- University of Victoria
Beverley Lawson, BSc (Hons), MSc -- Dalhousie University
Doug Manuel, BSc, MD, MSc -- University of Ottawa
Emily Marshall, BA, MSc, PhD -- Dalhousie University
Nandini Natarajan, MD, CCFP, FCFP -- Dalhousie University
Tara Sampalli, B.Eng, MASc (Biological Engineering), PhD -- Capital District Health Authority
Peter Tanuseputro, BSc, MHSc, MD -- Ottawa Hospital
Cheryl Tschupruk, BA (Hons), MSW, RSW -- Cancer Care Nova Scotia
Knowledge Users and Partners:
Bill VanGorder -- National Initiative for the Care of the Elderly
Nova Scotia Health Authority
Nova Scotia Health Research Foundation
Nova Scotia Hospice Palliative Care Association
Project Contact: Robin Urquhart -- Robin.Urquhart@nshealth.ca
Key words: frail; older adults; family practice; end-of-life; advance care planning